Are there times you imagine Alexandra all grown up?

Yes, I do.

In one version of the future, Alexandra Lee Valoras… slips into her own skin.

     Alexandra is Comfortable, Confident & Quirky

Out in the city with her friends, on a warm, August evening. Alexandra talks about a guy at work who, with a little coaxing recently asked her out on a date.

     Alexandra is Radiance

The waiter hands Alexandra a cranberry, vodka seltzer, and smiles at her as he walks away. Alexandra comments, “He’s cute too!”

     Alexandra is Authenticity & Exploration

Because, I am your dad, I know your heart

Because, I’ve always known your heart

Because, I am your heart

We are one.

I see you Alexandra

I see you “Wa-tutra”

          I know Dad

          I see you too

-I see you, by Dean Valoras

                                                     

                                                      ***

Sometimes Dean Valoras imagines his oldest daughter, Alexandra, all grown up. She’d wear her curly hair untamed -- straightening it just seemed like a trivial waste of time, she’d once remarked. She’d have degrees and awards to her name, but she’d never boast or belittle. No matter what accolades she’d have garnered, she’d feel most satisfied by being a friend and doing good.

It’s not a stretch to imagine Alexandra as such an incredible young woman. As a teenager, she showed every sign of success: an honors student who was involved in her school and community, a robotics whiz who had her sights set on MIT. She was beloved by her parents, siblings and friends, and by all accounts seemed happy and full of life.

But inside, there was an anguish no one saw. And instead of growing into the woman her father can picture in his head, Alexandra slipped out of her Grafton home in the early hours of a cold March morning in 2018, walked to nearby Mass. Pike overpass, and jumped.

Alexandra Lee Valoras, a 17-year-old high school junior, is one of thousands of teens who die by suicide every year. The rates of suicide among 15- to 19-year-olds has been rising for the past decade, and it is currently the second-leading cause of death among people ages 10 to 24, according to the U.S. Centers for Disease Control and Prevention. Even more disturbing are national surveys that tell us that 17 percent of high school students admit to thinking about suicide and almost 9 percent acknowledge actually making an attempt.

Still, it was something the Dean and Alysia Valoras never had on their radar. Alexandra, the oldest of their three children, was a high-achieving engineering student at Blackstone Valley Technical Vocational High School. She showed no outward signs of concern. She volunteered at the Grafton Community Barn, joined her family at the dinner table every night, had friends, drive, and plans for the future.

“She was comfortable in her geekiness. She seemed happy with who she was; happy in her shoes and comfortable in her self-image,” her mom, Alysia, recalled. “But it was so not -- so not how she saw herself in her journal. Not even close.”

A secret self

On the overpass from which she jumped, along with her jacket and boots, Alexandra left two journals that revealed “a different person all together” than the girl her family knew. When her parents look back on her first entries in August 2017, six months before her death, they said they see some resemblance to the Alexandra they knew, but progressively, things changed. By October, she was writing, almost whimsically, about suicide. And day after day, week after week, her entries grew more negative, sour, self-loathing.

“‘I’m not worth it.’ ‘I can’t do it.’ She’d write all these ways of how she was unworthy,” said Dean. Meanwhile, her grades stayed top-notch, even went up a bit. She participated in extra-curricular activities, went on trips with her family, and played guitar in the den with her dad. Aside from showing some stress about an upcoming AP exam, her parents saw nothing of the girl in the journal.

In December, she went to see a Scottish rock band with her dad at the Palladium in Worcester. They laughed and danced on the balcony, and he videoed her smiling in her seat, taking it all in. “That night she went home and wrote ‘I had to put on a face, show I was having a good time,’” Dean said. “There was an effort on her part that she had to put on a smile. But to us, there wasn’t really a reason to be concerned.”

Signs to look for

Suicide can caused by a constellation of risk factors and underlying vulnerabilities, and biologically, teens may be more susceptible.

“Teenage brains are still developing and the emotional center of the brain develops faster than the part of the brain that impacts judgment and decision making. This results in teens and young adults being more susceptible to impulsive actions in response to intense feelings,” said Brian Skehan MD, PhD, the Director of Child Emergency Mental Health and Associate Director of Child & Adolescent Psychiatry Training at the University of Massachusetts Medical School.

Many teens at risk for suicide display warning signs. “Paying attention to changes in sleep, food intake, and school performance may be the most objective measures to monitor. Even ‘angsty’ teens need to eat and sleep,” said Dr. Skehan. More subtle signs include withdrawing from friends and family, seemingly excessive physical complaints, and changes in mood, including persistent sadness. Changes in substance use may also indicate emotional pain and increase the risk of impulsive actions.

Teens at risk may also display signs of depression like decreased energy, or spending less time with peers or participating in activities that they used to enjoy, but Skehan noted that depression and suicidal thoughts are not the same.

“Suicidal thoughts can be present when teens are stressed, feel pressure to perform, or are experiencing self-doubt or loss,” he said.

But what about the Alexandras of the world? The teens who show seemingly no outward signs of risk? Dean and Alysia said since their daughter’s death, they’ve heard from dozens of parents across the country who had an Alexandra of their own -- a thriving and seemingly happy kid, who left them blindsided when they took their life.

“The signs that we saw didn't translate to signs of suicide. What she showed, and what we saw, it still doesn’t fit,” said Alysia. 

Starting the conversation

Dean remembers a particular ride home from school on an afternoon not long before his daughter’s death. Alexandra got in the car, put on a song, turned the volume up loud, and they drove home without speaking.

“I read that as, wow, my daughter’s cool with me being present when she’s clearly had a shitty day of high school. So I didn’t dwell or press her on talking. All I asked her was, ‘seems like you had a bad day?’ And she said, ‘dad you don’t know the half of it.’ That was probably my sign that we should sit down and talk about it, but instead I said, ‘let’s go in and have dinner,’” he said. “Oh, the dance of being a parent. When do you pry? When do you engage, and when do you let it go?”

Looking back, Alysia wishes she had been more frank.

“I think right up front I would ask her, ‘are you thinking of hurting yourself?’” I never had asked her that, but I think I would. If anything I guess it could have been maybe the rope that she needed us to throw her so that she could climb out,” she said.

Suicide is a difficult topic, but it’s too important to ignore. The incidence of suicide across all age groups has increased over the last 10 years but the rates of suicide have been rising even faster among people ages 15 to 24. While research has identified the increase in rate, the cause of this rise is less clear. What we do know is that talking openly about suicidal thoughts and feelings can help save a life.

Dr. Skehan reassures parents that it is OK to bring it up. “There is no evidence that parental concern can increase a youth’s risk. In fact, asking your child about suicide may reassure them that somebody cares. Parent’s comfort in talking about suicide may encourage youth to be more open with their thoughts instead of feeling alone and isolated with their worry and despair.”

If the discussion isn’t prompted by something your child is saying or doing that worries you, the Society for the Prevention of Teen Suicide (SPTS) recommends approaching the topic in the same way as other subjects that are important to you, but may or may not be important to your child. Pick a time when you have their attention, like a car ride, or after a suicide has received media attention to bring up the subject. If this is a hard subject for you to talk about, admit it. The SPTS suggests saying something like, “You know, I never thought this was something I’d be talking with you about, but I think it’s really important.”

Ask your child how they’re doing, what’s happening in their world these days, and what their concerns are. It can start simply by asking, “Are you okay?” Parents should listen without judgement, ask open-ended questions, and validate their children’s feelings. There is a full guide to starting the conversation here.

Out of the darkness

In the 18 months since Alexandra’s death, the Valoras family has granted with interviews with journalists from around the country. Last summer, the Boston Globe published their story along with dark snippets of Alexandra’s journals. In March, the CBS Sunday Morning Show aired a piece featuring the family. They’re open with Alexandra’s hidden anguish, and their own agony, because they are determined to take the topic of suicide out of the shadows, and to advance a dialogue around it.

In February, almost a year after he was shattered by her death, Dean started a public blog; a way to work through his own emotions that offers a glimpse into the grief of a suicide survivor. The Rising Blue is where he writes open letters to Alexandra and channels his thoughts, memories, and hopes.

Alysia has opened up in a different way. She was part of a community forum in Grafton that explored mental health issues among adolescents. In February, she spoke to 200 high school students at Whitinsville Christian School about teen suicide, encouraging them to reach out to someone if they’re in a crisis. Later she heard that nearly two dozen of those kids had visited the guidance office and asked for help.

This fall, Alysia will be speaking at a high-achieving district in West Lafayette, Indiana, and has plans to talk to students at another school in Texas.

“I want to explore if it’s a way I can affect some change. I want to let them know her story, who Alexandra was, and throw out that lifeline. Know that if they are starting to think about this, even a little bit, to talk to someone. I want to reach someone sooner,” she said. She can be reached for possible speaking engagements at alysiavaloras@gmail.com.

If you think your child is at risk

Any youth with suicidal thoughts should have an immediate evaluation by a trained mental health professional, said Dr. Skehan. Limiting access to prescription drugs and firearms (two of the three leading mechanisms of suicide in youth) can reduce access to lethal options.

For emergent concerns, youth mobile crisis clinicians are available throughout the state by calling 1-877-382-1609 or they can be seen in your local emergency room. Primary care offices, school guidance offices, and behavioral health clinics are other options for less urgent concerns, said Skehan. The National Suicide Prevention Lifeline is also available 24 hours a day for individuals or concerned loved ones at 1-800-273-8255.

Suicide Prevention Resources

National Suicide Prevention Lifeline

The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources. 1-800-273-8255.

Crisis Text Line

Every texter is connected with a Crisis Counselor, a real-life human being trained to bring texters from a hot moment to a cool calm through active listening and collaborative problem solving, 24/7. Text “HOME” to 741-741.

The Trevor Project

The TrevorLifeline is a 24/7 hotline for young LGBTQ people in crisis, feeling suicidal, or in need of a judgement-free place to talk. 1-866-488-7386.

Trans Lifeline

Peer-support hotline run by and for trans people. 877-565-8860.

The Samaritans Statewide

Call or text this crisis helpline. 877-870-4673.

Massachusetts Coalition for Prevention of Suicide

Local resources and regional coalitions.